Missed Medial Clavicular Physeal Fracture-Posterior Dislocation Complicated by Brachiocephalic Pseudoaneurysm: A Case Report.

CASE: We present a 17-year-old male patient with an initially missed posterior sternoclavicular fracture dislocation who presented with symptoms related to thrombotic emboli arising from a pseudoaneurysm. He was treated 6 weeks after injury with a figure-of-eight tendon allograft repair with good clinical outcomes. CONCLUSION: This is a unique presentation that highlights the significant risk of a missed diagnosis, life-threatening complications that may ensue, and biomechanically superior surgical intervention.

Successful recovery from cardiac arrest due to atlantoaxial subluxation in Down syndrome: a case report.

INTRODUCTION: Down syndrome is the most common chromosomal abnormality associated with intellectual impairments. Unexpected deaths are common with this disease. There are certain difficulties in clarifying the cause of death because the manifestations may be quite diverse and involve many organ systems. Atlantoaxial subluxation is a dangerous complication of Down syndrome, as it may lead to cervical cord-medullary compression. CASE PRESENTATION: Herein, we present a case of Down syndrome in a patient who completely recovered from cardiac arrest due to atlantoaxial subluxation. The neck was immobilized during post-cardiac arrest care, and the patient underwent surgery after 14 days. The patient could walk independently and was discharged 3 months later. At the last follow-up 5 years after surgery, the patient's general condition was good. DISCUSSION: Physicians should be aware that atlantoaxial instability can cause cardiac arrest in patients with genetic syndromes.

Demographics and Outcomes of Glenohumeral Dislocations in Individuals With Elevated Body Mass Index.

INTRODUCTION: No specific study has investigated the characteristics and outcomes of anterior shoulder dislocations in morbidly obese individuals. The purpose of this study was to describe shoulder dislocations in patients with body mass index (BMI) greater than 40. METHODS: A retrospective review was conducted to identify patients aged 18 years and older with a BMI ≥40 who presented with a shoulder dislocation in a single institution from 2000 to 2020. Dislocation patterns, associated injuries, treatment modalities, and associated complications were recorded. RESULTS: A significant increase was noted in the number of patients with BMI greater than 40 presenting per year (r2 = -0.831, P < 0.01) over the past 20 years. A significant increase was noted in the average BMI per year in this population (r2 = 0.504, P = 0.028). Fifteen patients (19.5%) experienced at least one recurrent dislocation episode. Ten patients had a Bankart lesion that was associated with an elevated BMI (P = 0.04). Nine patients (11.7%) sustained an associated neurologic injury (no association with BMI). CONCLUSIONS: Over time, there has been an increase in shoulder dislocations in morbidly obese individuals in the United States, alongside an overall increase in the average BMI of patients who present with shoulder dislocations.

Isolated Subtalar Dislocations: Insights from a Case Study and Literature Review.

Background: Isolated subtalar joint dislocations without associated fractures are rare in the medical literature. They occur when the talus bone remains in place while the calcaneus and navicular bones shift out of place. These dislocations account for about 15% of talus bone injuries and 1 to 2% of all joint dislocations. They are more common in young men following inversion trauma. Objective: This study aims to improve the understanding of diagnosis, treatment, and management of these rare injuries for better patient care. Case presentation: 17-year-old male patient with type 1 diabetes mellitus presented to the emergency department with severe ankle pain and swelling following an inversion injury, which rendered him unable to walk or stand. Despite his chronic condition, he was hemodynamically stable, with no neurovascular deficits but an apparent deformity in the left ankle. Treatment involved pain management with morphine, successful closed reduction under ketamine sedation, and immobilization. Follow-up radiographs and a CT scan revealed no fractures but indicated soft tissue edema, joint effusion, and subsequent osteopenia. At a three-month follow-up, the patient experienced ongoing pain and weight-bearing difficulties, diagnosed as complicated pain syndrome requiring further physiotherapy and rehabilitation. Conclusion: This case highlights the clinical challenges and complications in managing isolated subtalar joint dislocations, particularly in patients with systemic health issues, and contributes valuable insights to the sparse literature on this topic.

Technical note: Traumatic atlanto-occipital dislocation and severe subaxial cervical distraction injury in an infant.

INTRODUCTION: Traumatic injuries of the spine requiring surgery are rare in infancy. Fusion procedures in the very young are not well-described at the atlanto-occipital junction or subaxial spine. Here we describe novel segmental posterior instrumentation in a severe spinal column disruption in an infant. CASE PRESENTATION: A 13-month-old male with atlanto-occipital dislocation and severe C6-7 distraction (ASIA impairment scale A) presented after a motor vehicle accident. He underwent instrumented fusion (occiput-C2 and C6-7) and halo placement. Postoperative imaging demonstrated reduction of the C6-7 vertebral bodies. Physical examination showed lower limb paraplegia and preserved upper extremity strength except for mild weakness in hand grip (3/5 on the MRC grading scale). Occiput-C2 instrumentation was performed using occipital keel and C2 pedicle screws with sublaminar C1 polyester tape. C6-7 reduction and fixation was performed with laminar hooks. Arthrodesis was promoted with lineage-committed cellular bone matrix allograft and suboccipital autograft. Anterior column stabilization was deferred secondary to a CSF leak. Intraoperative monitoring was performed throughout the procedure. Within 1 month after surgery the patient was able to manipulate objects against gravity. CT imaging revealed bony fusion and spontaneous reduction of C6-7. DISCUSSION: Spinal instrumentation is technically challenging in infants, regardless of injury mechanism, particularly in cases with complete spinal column disruption, but an anterior fusion may be avoided in infants and small children with posterior stabilization and halo placement.

Entrapment of median nerve after elbow fracture dislocations: expected surgical time frame based on cadaver study.

INTRODUCTION: Median nerve injuries occur in approximately 3% of pediatric elbow fracture dislocations. These rare injuries can be difficult to diagnose, and the results are poor in delay cases. Surgical timing is one of the most important prognostic factors. We aimed to present three patients with median nerve palsy who were referred to our clinic late, and according to these cases, we emphasized the expected time frame for exploration based on our anatomical cadaver study. MATERIALS AND METHODS: Between 2008 and 2010, three patients were referred to our clinic because of median nerve paralysis after a treated elbow dislocation. The mean interval between injury and referral was 15 (min: 13-max: 18) months, and the mean age of the patients was 15 (13-18) years. Neurolysis was performed in two patients, and for the third patent, after neurolysis, axonal continuity was observed to be disrupted so sural nerve grafting was performed with four cables. Tendon transfers were performed in all patients. A total number of 20 upper extremities of 10 cadavers were dissected. Due to its proximal innervation and ease of assessment, the muscle innervation of the flexor pollicis longus (FPL) was planned to be evaluated. The distance from the medial epicondyle is calculated in the cadaver study where the nerve injury is found. RESULTS: The mean length from the medial epicondyle to the motor innervation of FPL was calculated in each specimen and found to be 101.99 millimeters (mm) (range: 87.5-134.2). The mean longest innervation of FPL was 110.83 mm from (range 87.5-148.1) the medial epicondyle calculated by including each specimens longest nerve length. Knowing that the healing time of a nerve lesion is 1 mm per day, we calculated that the recovery of FPL would take approximately 4 months. CONCLUSION: When nerve healing is expected to be 1 mm a day in axonotmesis type injury, after the median nerve palsy following elbow dislocation, thumb flexion should be achieved in the following 4 months generally if the nerve was not entrapped in the joint. This cadaver-based study objectively defined how long to wait for the innervation of the FPL in median nerve injuries in elbow fracture dislocations.

Preparing for and Executing the Ideal Posterior Labral Repair.

Posterior labral tears are a source of pain and instability of the shoulder. Despite being relatively uncommon (reported in approximately 10% of instability cases), the incidence of posterior labral tear is increasingly recognized as underestimated in highly active populations. Posterior labral tears can result from a traumatic posterior dislocation or repetitive microtrauma, leading to posterior chondral/labral attrition. Patients often present with vague, deep-seated shoulder discomfort rather than the sensation of instability. Unfavorable results with nonsurgical management will indicate which patients will most benefit from surgery. Arthroscopic stabilization has proven to be an effective and reliable treatment, and many techniques for posterior labral repair have been described. It is important to highlight the evaluation, preparation, and execution of arthroscopic stabilization of an isolated posterior labral repair using high-strength knotless all-suture anchors to allow for a stable, efficient, reproducible, and reliable repair while maintaining a low-profile construct that minimizes damage to the surrounding tissue.

Traumatic Irreducible Pediatric Radial Head Dislocations: A Unique Case and Review of the Literature.

Background: Irreducible radial head dislocations are uncommon injuries and blocks to reduction typically result from interposed soft tissue. We report the case of a pediatric patient who sustained an irreducible radial head dislocation with a concomitant posterior elbow dislocation and coronoid process fracture. To the author's knowledge, irreducible radial head dislocations presenting as part of a terrible triad like constellation of injuries have not been previously reported. A case-based review of the literature was also performed. Case Description: A 7-year-old male presents to our pediatric hospital as a transfer from an outside hospital after sustaining a posterolateral radial head and posterior elbow dislocation secondary to a fall. CT imaging and 3D reconstruction revealed a Type 1 coronoid process fracture. At our institution, closed attempts at reduction in the operating room under fluoroscopy with general anesthesia were also unsuccessful. Open reduction of the radial head and repair of the soft tissue structures was ultimately required to stabilize the patient's elbow injury. Conclusion: Irreducible pediatric radial head dislocations are rare and inherently unstable injuries. To the authors' knowledge, there are no prior reports of irreducible radial head dislocations that present in a terrible triad like fashion with a coronoid process fracture and posterior elbow dislocation. In the present report, successful treatment of this injury required open reduction and soft tissue repair. Level of Evidence: IV.

Traumatic recurrent hip dislocation associated with femoral head fracturere constructed with iliac crest autograft / Luxación recurrente de cadera asociada a fractura de cabeza femoral reconstruida con autoinjerto de cresta iliaca

Hip femoral head fractures are extremely uncommon, but likely associated with traumatic hip dislocations. Both lesions require emergent treatment to avoid further complications.19-year-old male patient was received after a high-energy motor vehicle accident with severe brain and thoraco-abdominal trauma and a displaced femoral head fracture with posterior hip dislocation with no acetabular fracture. An emergent open reduction and internal fixation with 2 headless screws was performed, as well as posterior capsule repair. After 1 month as an inpatient in Intensive Care Unit, he sustained a new episode of posterior hip dislocation. Consequently, a second successful surgical reduction was obtained, and hip stability was achieved by posterior reconstruction with iliac crest autograft fixed with cannulated screw and posterior structure repair. Two years later, he was able to walk independently and he does not present any signs of degenerative joint disease nor avascular necrosis.

Las fracturas de la cabeza femoral son extremadamente raras y están asociadas comúnmente con una luxación de cadera traumática. Ambas lesiones requieren tratamiento urgente con el objetivo de evitar complicaciones posteriores. Un paciente varón de 19 años fue trasladado tras un accidente de tráfico de alta energía en el que sufrió un traumatismo craneoencefálico y toracoabdominal grave, además de una fractura de cabeza femoral desplazada junto a una luxación posterior de cadera sin afectación acetabular. De manera urgente, fue intervenido mediante una reducción abierta y fijación interna de la fractura con dos tornillos canulados sin cabeza y reparación de la cápsula articular posterior. Tras un mes de ingreso en la unidad de cuidados intensivos, sufrió un nuevo episodio de luxación posterior de cadera. Debido a ello, se realiza una segunda intervención quirúrgica con reducción abierta y en la que se obtiene una adecuada estabilidad de la cadera mediante reconstrucción posterior con la adición de autoinjerto tricortical de cresta ilíaca y reparación capsular posterior. Después de dos años de seguimiento, el paciente deambula de manera independiente, sin dolor y sin signos degenerativos ni de necrosis avascular en las pruebas de imagen.

Tratamento cirúrgico de luxação recidivante da mandíbula: relato de caso / Surgical treatment of recurrent mandible luxation: case report

Introdução: A articulação temporomandibular (ATM) é uma estrutura especializada e excepcional, relacionada com funções estomatognáticas e propensa à disfunções associadas ao sistema maxilo-mandibular. Dentre essas alterações, a luxação é uma entidade patológica importante. Possui patogênese multifatorial e pode se manifestar de modo recidivante. Diversos tratamentos são propostos, dentre eles, a criação de anteparos aloplásticos. Paciente do sexo feminino, 22 anos com história de luxação mandibular recidivante com sintomatologia congruente ao quadro. Realizou-se tratamento cirúrgico com instalação de miniplacas de titânio do sistema 2.0 mm em forma de duplo T com curvatura de aproximadamente 90°, na região de eminencia articular. Após 1 ano e 6 meses, a paciente segue assintomática, sem lesões nervosas e sem luxações. A luxação da ATM é um quadro clínico angustiante, sendo a segunda luxação mais frequente e incidente em mulheres. Caracteriza-se por: incapacidade de fechar a boca, depressão cutânea pré-auricular, ptialismo e musculatura mastigatória tensa. A paciente apresentava severas luxações recidivantes, juntamente com ansiedade e angústia social. A utilização de placas evitou a hiperexcussão e remissão do quadro. É um procedimento menos agressivo e reversível. A técnica utilizada demonstrou bom prognóstico e, dentre as opções cirúrgicas, é uma técnica mais conservadora... (AU)

Introduction: TMJ dislocation is a multifactorial joint pathology that occurs when the mandibular condyle exceeds the articular eminence and cannot return to its original anatomical position, making it impossible for the patient to close the mouth. A 22-year-old female patient complaining of succes sive episodes of mandibular dislocation, characterizing the condition of dislocation redicivant TMJ. Surgical treatment was performed with the installation of 2.0 mm double T-shaped titanium miniplates with approximately 90° curvature in the region of articular eminence. After 8 months, the patient has no complaints, no signs of facial nerve damage and no episodes of dislocation. TMJ dislocation is a socially and psychologically distressing clinical condition, being the second most frequent dislocation in the body and with higher incidence in female patients. Key features are inability to close the mouth, pre auricular cutaneous depression, excessive salivation, and tense and spasmodic masticatory muscles. In this case, the patient presented severe relapsing dislocations, along with anxiety and social anguish. The use of plates acts as a mechanical barrier for condylar movements, avoiding hyperexcussion, being a less aggressive and reversible procedure, having only the disadvantage of the possibility of plate frac ture. The technique used with the objective of limiting condyle movement, among the surgical options, is a more conservative technique... (AU)

Luxaciones puras de codo en pacientes pediátricos: tratamiento conservador y complicaciones asociadas a una patología poco prevalente. Serie de 4 casos / Isolated elbow dislocation in pediatric patients: non-operative treatment and complications associated with an infrequent pathology. Series of 4 cases

Si bien el codo es la articulación más frecuentemente luxada en niños, representa el 3-6 % de las lesiones en ese sitio. Las luxaciones sin fracturas asociadas son muy raras y son producto de una caída con el codo en extensión. El paciente consulta por dolor, impotencia funcional y deformidad evidente. La finalidad del tratamiento es restaurar la congruencia articular, lograr estabilidad y minimizar los riesgos de posibles lesiones neurovasculares.Se presentan 4 pacientes tratados con manejo conservador con excelentes resultados funcionales, incluso aquel que presentó una neuropraxia del mediano con restitución ad integrum.Según nuestra experiencia, suelen ser lesiones con buena evolución. Se destaca la importancia de un rápido y preciso examen neurovascular, optando, de ser posible, por una conducta expectante ante las lesiones nerviosas. Se resalta la indicación de una inmovilización acotada con movilización temprana que evite rigidez del codo.

Even though the elbow is the most often dislocated joint in children, this injury accounts for 3-6 % of elbow pathology. Dislocations without associated fractures are extremely rare. They result from a fall onto an outstretched hand. The patient is always referred with a painful joint, movement impairment and even clinical deformity. Acute treatment aims to achieve quick reduction and adequate joint stability, avoiding neurovascular injuries.We sought to analyze the functional outcomes and the complications after non-operative treatment. Our 4 patien had excellent functional results at the latest follow-up, and one of them suffered from a median nerve palsy without further consequences.In our experience, these injuries presented excellent outcomes and we would like to highlight the importance of a quick and precise neurovascular examination with the possibility of non-surgical management of nerve injuries. A short period of immobilization with early rehabilitation should be indicated to avoid joint stiffness

Subluxación atloaxoidea. Emergencia en la atención clínico quirúrgica / Atlantoaxial subluxation. Emergency in clinical surgical care

Introducción: la subluxación atloaxoidea es un trastorno de la columna cervical, a nivel de las vértebras C1 y lC2 que causa deterioro en la rotación del cuello porque la faceta anterior de C1 se fija en la faceta de C2. Objetivo: enfatizar la importancia del diagnóstico temprano de la subluxación atlantoaxoidea en pacientes con o sin evidencia de trauma para que sea identificada como emergencia clínico quirúrgica. Desarrollo: en el presente trabajo se enfatiza en la necesidad de identificar eventos o complicaciones de la subluxación atloaxoidea que pongan en peligro la vida de los pacientes y requieran de la atención clínico quirúrgica de manera emergente por la compresión de médula espinal que puede ocasionar, de modo que en algunos reportes bibliográficos es clasificada como una emergencia. Conclusiones: existen muchas formas de presentación de la subluxación atloaxoidea, muchas de ellas pueden cursar con complicaciones que constituyan emergencias, así como variados tratamientos que deben ser valorados críticamente porque pueden ocasionar consecuencias mayores que la propia enfermedad, lo que habla a favor de lo imprescindible de un diagnóstico certero y de un enfoque multidisciplinar(AU)

Introduction: the atlantoaxial subluxation is a disorder of the cervical spine, at the level of the C1 and C2 vertebrae that causes deterioration in the rotation of the neck because the anterior facet of C1 is fixed on the facet of C2. Objective: To emphasize the importance of early diagnosis of atlantoaxial subluxation in patients with or without evidence of trauma to be identified as a surgical clinical emergency. Development: In the present work, emphasis is placed on the need to identify events or complications of atlantoaxial subluxation that endanger the life of patients and require surgical clinical attention in an emergent manner due to the compression of the spinal cord that may result from so that in some bibliographic reports it is classified as an emergency. Conclusions: There are many forms of presentation of atlantoaxial subluxation, many of them can present complications that constitute emergencies, as well as various treatments that must be critically evaluated because they can cause greater consequences than the disease itself, which speaks in favor of the essential of an accurate diagnosis and a multidisciplinary approach(AU)

Ultrasound-guided costoclavicular block as an alternative for upper limb anesthesia in obese patients / Bloqueio costoclavicular guiado por ultrassonografia como alternativa para anestesia de membro superior em paciente obeso

Abstract Background and objectives: Costoclavicular brachial plexus block is an anesthesia performed through the infraclavicular route described in the literature as a safe and effective route for upper limb anesthesia distal to the elbow. The following report describes the case of a patient whose traditional plexus blocking techniques presented ultrasound visualization difficulty, but the costoclavicular approach was easy to visualize for anesthetic blockade. Case report: A grade 3 obese patient scheduled for repair of left elbow fracture and dislocation. Ultrasound examination revealed a distorted anatomy of the supraclavicular region and the axillary region with skin lesions, which made it impossible to perform the blockade in these regions. It was decided to perform an infraclavicular plexus block at the costoclavicular space, where the brachial plexus structures are more superficial and closer together, supported by a muscular structure, lateral to all adjacent vascular structures and with full view of the pleura. The anesthetic block was effective to perform the procedure with a single injection and uneventfully. Conclusion: Costoclavicular brachial plexus block is a good alternative for upper limb anesthesia distal to the elbow, being a safe and effective option for patients who are obese or have other limitations to the use of other upper limb blocking techniques.

Resumo Justificativa e objetivos: O bloqueio de plexo braquial via costoclavicular é uma anestesia feita por via infraclavicular, já descrita na literatura como uma via segura e efetiva para anestesia de membro superior distal ao cotovelo. O relato a seguir trata de um paciente em que as técnicas tradicionais para bloqueio de plexo apresentavam dificuldade de visibilização à ultrassonografia, já a via costoclavicular foi de fácil visibilização para execução do bloqueio anestésico. Relato de caso: Paciente com obesidade grau 3 a ser submetido a correção de fratura e luxação de cotovelo esquerdo apresentava anatomia da região supraclavicular distorcida à avaliação ultrassonográfica e região axilar com lesões de pele, que impossibilitavam o bloqueio nessas regiões. Optou-se por fazer o bloqueio de plexo via infraclavicular no espaço costoclavicular, região onde as estruturas do plexo braquial estão mais superficiais e unidas, amparadas por uma estrutura muscular, laterais a todas as estruturas vasculares adjacentes e com a visibilização plena da pleura. O bloqueio anestésico foi efetivo para a realização do procedimento sob punção única em pele e sem intercorrências. Conclusão: O bloqueio de plexo braquial via costoclavicular é uma boa opção para anestesia de membro superior distal ao cotovelo, é uma opção segura e efetiva para pacientes obesos ou que tenham outras limitações à aplicação de outras técnicas de bloqueio de membro superior.

Luxación congénita de cabeza radial: reporte de dos casos / Congenital radial Head dislocation: report of two cases

Resumen: Introducción: La luxación congénita de cabeza radial es un padecimiento que se ha descrito en contados casos en la literatura internacional, siendo la luxación anterior y lateral las formas de presentación menos frecuentes con 15% de los casos cada una y la luxación posterior la más frecuente con 70% del total de los casos reportados. Sin embargo, esta patología es considerada la patología congénita más frecuente del codo en el niño. Se presenta el caso de un paciente con luxación congénita de codo variedad anterior y otro caso con luxación variedad lateral, ambos diagnosticados a temprana edad, en los que se decidió realizar un manejo conservador y un seguimiento anual. Asimismo, se hizo una revisión bibliográfica del tema. Discusión: La luxación congénita de codo tiene por lo general una evolución benigna, siendo indolora y poco limitante para el paciente, por lo que puede ser manejada de manera conservadora. El dolor y la limitación de movimientos son indicativos de un tratamiento quirúrgico; sin embargo, no son ampliamente aceptados debido a las complicaciones y resultados deficientes que presentan.

Abstract: Introduction: Congenital dislocation of the Radial head is a condition that has been described in a few cases in the international literature, the anterior and lateral dislocation were the less frequent forms of presentation with 15% of cases, each, and the posterior dislocation the most frequent with 70% of the total cases reported. However, this pathology is considered the most frequent congenital pathology of the elbow in children. The present study describes the case of a patient with congenital dislocation of elbow anterior variety and another case with dislocation lateral variety, both diagnosed at an early age, in which it has been decided for conservative management and an annual follow-up. A bibliographic review of the subject is also carried out. Discussion: The congenital elbow dislocation usually has a benign evolution, being painless and not very limiting for the patient, so it can be managed conservatively. Pain and limited movement are indicative of surgical treatment. There are multiple surgical treatments for this entity, however they are not widely accepted due to the complications and poor results presented by them.

Inestabilidad postraumática de codo: revisión bibliográfica / Post-traumatic instability of the elbow: review / Instabilidade pós-traumática do cotovelo: revisão bibliográfica

Introducción: Las luxaciones constituyen del 10 % al 25 % de todas las lesiones en el codo. Aproximadamente el 15% de los pacientes que la han sufrido quedan con algún síntoma compatible con inestabilidad. El objetivo de este trabajo es revisar en la literatura los diferentes tratamientos propuestos para esta complicación luego de una luxación simple de codo. Materiales y Métodos: Se realizó una búsqueda en bases de datos: Medline (interfase Pub-Med) y Bireme para estudios de los últimos diez años. Se seleccionaron los artículos que cumplieron los criterios de inclusión y exclusión, extrayendo de ellos los datos relevantes y resultados. La búsqueda arrojó un total de 596 artículos de los cuales 10 cumplían con los criterios de inclusión propuestos al iniciar la búsqueda. Discusión: Se analizaron y compararon las tasas de inestabilidad luego de la luxación, los diferentes tipos de tratamiento y las complicaciones. Conclusión: Existe consenso en la literatura analizada de que debe realizarse un examen de estabilidad del codo en agudo para definir el tratamiento. En cuanto al tratamiento en los codos que se presentan inestables la literatura es variable y faltan estudios comparativos para realizar recomendaciones.

Introduction: Dislocations are 10% to 25% of all elbow injuries. Up to 15% of patients with symptoms of instability can be observed. The aim of this study is to review in the literature the different treatments proposed for this complication after a simple elbow dislocation. Materials and Methods: The search was conducted on: Medline (PubMed interface) and Bireme including the last ten years studies. Articles that met the inclusion and exclusion criteria were selected, and the relevant data and results were extracted. We found a total of 596 articles, 10 met the inclusion criteria proposed at the start of the search. Discussion: We analyzed and compared the rates of instability after dislocation, the different types of treatment and complications. Conclusion: There is consensus in the analyzed literature that an elbow stability test should be performed in acute conditions to define the treatment.Comparative studies are lacking for recommending a definite treatment for elbow instability.

Introdução: Dislocaçõessão de 10% a 25% de todas as lesões no cotovelo. Aproximadamente 15% dos pacientes ficam com algum síntoma compatívelcom instabilidade. O objetivo deste trabalho é rever na literatura os diferentes tratamentos propostos para esta complicação a pósuma simples deslocação do cotovelo. Materiais e métodos: Uma pesquisa foi feita em bancos de dados: Medline (interface Pub-Med) e Bireme para estudos dos últimos dez anos. Foram selecionados artigos que atendem a os critérios de inclusão e exclusão, extraindo os dados relevantes e os resultados deles. A busca gerou um total de 596 artigos, dos quais 10 atendem a os critérios de incluso propostos no início da pesquisa. Discussão: Analisamos e comparamos as taxas de instabilidade após deslocamento, os diferentes tipos de tratamento e complicações. Conclusão: Existe consenso na literatura analisada segundo a qualum teste de estabilidade do cotobelo deve ser realizado em agudos para definir o tratamento. Sobre o tratamento os cotovelo sin stáveis a literatura é diversa e faltam estudos comparativos para realizar recomendações.

Análisis de las complicaciones en pacientes con fractura-luxación de Lisfranc / Complication analysis in Lisfranc fracture-dislocation

Resumen: Objetivo: Valorar las complicaciones y secuelas del tratamiento de la fractura-luxación de Lisfranc (FLL). Material y métodos: Se realizó un estudio de cohortes ambispectivo trasversal de 83 pacientes con diagnóstico de fractura-luxación de Lisfranc. Se utilizó un protocolo de recopilación de datos con variables relacionadas con la lesión, parámetros clínicos, terapéuticos, complicaciones y escalas de valoración clínica. Resultados: 66 pacientes (79.5%) presentaron complicaciones tanto precoces como tardías. Las complicaciones precoces sumaron nueve casos de edema postoperatorio, tres de infección superficial, dos de necrosis cutánea que precisó injerto libre de piel (ILPH), uno de lesión vascular, uno de tromboembolismo pulmonar (TEP), uno de pérdida de reducción en el postoperatorio precoz, uno de mala reducción que precisó de nueva intervención. Entre las complicaciones tardías, 41 pacientes (49.40%) presentaron signos radiológicos de artrosis en la articulación tarsometatarsiana, cinco con enfermedad de Sudeck que precisó tratamiento, ocho con descalcificación por desuso, 12 con edema residual, uno con pérdida de reducción en fase tardía, uno con cicatriz hipertrófica y brida retráctil, uno con osteomielitis crónica, uno con seudoartrosis, tres con intolerancia/infección tardía al material de osteosíntesis; también hubo reintervención de siete pacientes en fase de secuelas donde se les realizó artrodesis. No se observó ninguna rotura de material de osteosíntesis. Casi la mitad de los pacientes (49.4%) recibieron algún tipo de indemnización económica tras el accidente. Conclusiones: El tratamiento de las FLL debe realizarse lo antes posible, ya que la estabilización en un breve plazo de tiempo puede ayudar a mejorar los resultados. La reducción anatómica no predice los buenos resultados. Un número importante de pacientes refirió dolor residual.

Abstract: Objective: To value the complications and sequels for patients with Lisfranc's fracture-luxation (FLL). Material and methods: A transverse ambispective study of cohorts was realized of 83 patients by diagnosis of Lisfranc's fracture-luxation. There was in use a protocol of withdrawal of information with variables related to the injury, clinical, therapeutic parameters, complications and scales of clinical valuation. Results: 66 patients (79.5%) presented complications grouping early and late. Analyzing the early complications, we observe 9 cases of postoperatory edema with inflammation and swelling, 3 cases of superficial infection, 2 cases of necrosis cutaneous that precise graft should free of skin (ILPH), 1 case of vascular complication, 1 case of pulmonary embolis (TEP), 1 case of loss of reduction in the precocious postoperatory, 1 case of bad reduction that was necessary new intervention. The late complications presented the following distribution: 41 patients (49.40%) presented radiological signs of degenerative osteoarthritis in the tarsometatarsal joint, 5 cases of Sudeck's disease that needed treatment, 8 cases of decalcification for disuse, 12 cases of edema and residual inflammation, 1 case of loss of reduction in late phase, 1 case of hypertrophic scar with retractable bridle, 1 case of chronic osteomyelitis, 1 case of seudodegenerative osteoarthritis, 3 cases of late intolerance/infection to the osteosynthesis material, reintervention of 7 patients in phase of sequels where they were realized artrodesis. No break of material was observed of osteosynthesis. Almost the half of the patients (49.4%) they received some type of economic indemnification after the accident. Conclusions: The treatment of the FLL must be realized as soon as possible, providing that the general condition of the patient and of the soft parts allows it, since the stabilization in the brief space of time can help to improve the results. The anatomical reduction cannot grant a good result. An important number of patients had residual pain.

Luxación del codo y fractura del epicóndilo lateral en una niña de 5 años: Reporte de caso / Elbow dislocation and lateral epicondyle fracture in a five year-old girl: Case report

La luxación traumática del codo en la población pediátrica es un evento particularmente raro, descrito por primera vez por Stimson en 1900 y casi 100 años después retomada por Tachdjian en 1990, asociándose en 3% de las veces con fractura del epicóndilo lateral, constituyendo de esta manera una patología poco frecuente que ha sido descrita en contadas publicaciones como reportes de caso, no conociéndose claramente el mecanismo del trauma, el manejo que debe hacerse para estos pacientes ni las complicaciones derivadas; de esta manera presentamos el caso de una niña de cinco años con luxofractura de epicóndilo lateral manejada con reducción cerrada y fijación percutánea con clavos de Kirschner y con buenos resultados funcionales...

Traumatic elbow dislocation in the pediatric population is a particularly unusual injury. It was first described by Stimson in 1900 and almost 100 years later revisited by Tachdjian in 1990. Three percent of cases are associated with lateral epicondyle fracture, so this is an infrequent injury that has been described in only a few papers as case reports. The mechanism of injury is not clearly known, nor is the best type of treatment or its complications. We report herein the case of a five year-old girl with fracture dislocation of the lateral epicondyle who was managed with closed reduction and percutaneous fixation with Kirschner nails, with good functional results...

Ectrodactilia em cão: relato de caso / Ectrodactyly in dog: case report

Descreve-se um caso de ectrodactilia em um cão, sem raça definida e dois meses de idade. No exame clínico e radiográfico, foi verificada a separação óssea e de tecidos moles entre o segundo e o terceiro dígitos, estendendo-se proximalmente até a região distal do rádio e da ulna, e luxação do cotovelo ipsilateral. O animal foi submetido a procedimento cirúrgico para redução da luxação do cotovelo e reaproximação óssea e dos tecidos moles. Após 16 meses da cirurgia, o animal apresentava uso parcial do membro

A case of ectrodactyly is described in a 2-month-old male mixed Terrier dog. The defect was a complete osseous and soft tissue separation extending from between digits 2 and 3 proximally to the level of the radius and ulna. Radiography revealed elbow luxation. Treatment consisted of surgical reduction of elbow luxation and soft tissue reconstruction. Sixteen months after surgery, the dog was intermittent nonweight-bearing lameness